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PubMed2001

Structural integrity of the female condom after multiple uses, washing, drying, and re-lubrication.

Establishing the safety of re-using the female condom could significantly increase women's access to barrier methods especially in poorer countries. In this study, the structural integrity of female condoms was tested (n = 295) after multiple acts of vaginal intercourse. Fifty women were recruited to the study. Each woman re-used one condom up to eight times and washed, dried, and re-lubricated between each use. Structural integrity was measured using standard quality control testing; water-leakage, air-burst, and seam tensile strength. All results were compared to the United States Food and Drug Administration (US FDA) standards for an unused female condom. The results of the structural integrity tests for all cycles were above the FDA minimum standards for seam strength and burst tests. There was no deterioration detected in condoms used 8 times when compared to new female condoms in these tests. Five holes were detected by the water leakage test across all cycles, of which three were detected by the subjects themselves and reported to the investigators, therefore, giving a breakage rate of 1.7%. The holes were not associated with increased number of uses. This study provides further evidence that suggests the structural integrity of the female condom after multiple use is still within FDA minimum standards, although random holes resulting from handling occur infrequently with the re-use procedure.

Coitus↗
PubMed2002

Predictors of difficulty inserting the female condom.

This article describes the frequency of initial difficulty inserting the female condom and identifies predictors of insertion difficulty among women at risk of sexually transmitted diseases (STDs). Female STD clinic patients (n = 1144) were taught how to insert the female condom by using an anatomic model, then given an opportunity for self-insertion practice. Correct placement of the condom was verified by a nurse clinician, and the number of attempts required for correct insertion was recorded. Sociodemographic and psychosocial predictors of refusing the insertion practice and of difficulty inserting the female condom were evaluated using logistic regression. Only 5% of study participants refused the self-insertion practice. Women who never had a Papanicolaou smear test, did not use tampons, never used an inserted method of STD prevention/birth control, and disliked the insertion features of intravaginal barrier methods were more likely to refuse the self-insertion practice. Of those who attempted self-insertion, 25% were unable to insert the female condom correctly on the first attempt. Women who never expressed their sexual likes and were indifferent to the positive features of intravaginal contraceptive methods were more likely to experience difficulty their first insertion attempt. Other variables associated with insertion difficulty included longer fingernails. Insertion refusal and difficulty affect use of the female condom for a sizable proportion of women. Women in this study who refused the self-insertion practice had greater aversion to inserting intravaginal barrier methods. Women who had initial difficulty inserting the female condom had a different profile from those who refused and can benefit from intensive skills training that includes supervised self-insertion practice.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Imaging of esophageal tumors with a water-filled condom and a catheter US probe.

BACKGROUND: High-frequency catheter ultrasound (C-EUS) probes provide high resolution images of the gastrointestinal tract. Their use in the esophagus is limited by the requirement for a water-filled lumen for good acoustical coupling. We have developed a system using a condom that provides a continuous column of water for high resolution C-EUS imaging of the esophagus. METHODS: Nine patients underwent condom C-EUS for evaluation of esophageal mucosal and submucosal tumors. A standard latex condom was attached to a 2-channel endoscope and filled with water after esophageal intubation. A 20 MHz C-EUS probe placed within the water-filled condom was used to characterize all lesions. RESULTS: The condom C-EUS system provided a 360 degree, high resolution image throughout the length of the esophagus without air artifact and without the risk of aspiration associated with filling the esophageal lumen with water. Complete imaging of the tumor was obtained in all cases, and no additional C-EUS procedures were required. The condom C-EUS was subjectively rated superior overall in comparison to standard C-EUS by 4 independent endosonographers. CONCLUSIONS: Condom C-EUS is a new method of high resolution imaging of the esophagus. This method provides a contained column of water within the esophagus that improves image quality and ease of use and may reduce the risk of aspiration.

Adenocarcinoma↗
PubMed2006

Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data.

BACKGROUND: Drug therapy for people with AIDS is a humanitarian priority but prevention of HIV infection remains essential. Focusing on young single African women, we aimed to assess trends in a set of behaviours-sexual abstinence, contraceptive use, and condom use-that are known to affect the rates of HIV transmission. METHODS: We did a secondary analysis of public-access data sets in 18 African countries (132,800 women), and calculated changes in a set of behavioural indicators over time. We standardised these trends from nationally representative surveys to adjust for within-country changes in age, education, and type of residential location. FINDINGS: Between about 1993 and 2001, the percentage of women reporting no sexual experience changed little. During the same period, the percentage of sexually experienced women who reported no sexual intercourse in the previous 3 months (secondary abstinence) rose significantly in seven of 18 countries and the median for all 18 countries increased from 43.8% to 49.2%. Use of condoms for pregnancy prevention rose significantly in 13 of 18 countries and the median proportion increased from 5.3% to 18.8%. The median rate of annual increase of condom use was 1.41 percentage points (95% CI 1.12-2.25). In the 13 countries with available data, condom use at most recent coitus rose from a median of 19.3% to 28.4%. Over half (58.5%) of condom users were motivated, at least in part, by a wish to avoid pregnancy. INTERPRETATION: Condom promotion campaigns in sub-Saharan Africa have affected the behaviour of young single women; the pace of change has matched the rise in contraceptive use by married couples in developing countries over recent decades. Thus continuing efforts to promote condom use with emphasis on pregnancy prevention are justified.

Adolescent↗
PubMed2001

Determinants of condom use intentions of university students in Ghana: an application of the theory of reasoned action.

The study examined the applicability of the Theory of Reasoned Action to the study of condom use intentions of students at a university in southern Ghana. The data supported the model, explaining 33% of the variance in students' condom use intentions. Subjective norms and the perceived disadvantages of condom use were significant determinants of intention, with the former being more important. Respondents who intended to use condoms consistently ("intenders") and those with no such intentions ("non-intenders") were equally motivated to comply with the wishes of their significant referents (sexual partners, close friends, parents and medical doctors). The critical difference was that "intenders" consistently held a stronger belief than "non-intenders" that their significant referents approved of condom use. Significantly, whereas "intenders" believed that their sexual partners would approve of condom use, the "non-intenders" held the contrary belief that their partners would disapprove of such behavior. This suggests that AIDS education interventions targeting a similar audience like the university students in this study should shift their foci away from individuals alone and instead, focus simultaneously on individuals, their sexual partners and their broader social networks in order to enhance perceptions of peer acceptance of condom use.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Expanding safer sex options: introducing the female condom into national programmes.

Although the female condom has been introduced into over 90 countries since 1997, it has only been accepted in sexual and reproductive health programmes as a mainstream method in a few. This paper describes introductory strategies developed by Ministries of Health and non-governmental organisations in Brazil, Ghana, Zimbabwe and South Africa, supported by UNAIDS, and the manufacturers of the female condom, which have significantly expanded the number of female condoms being used. These projects have several key similarities: a focus on training for providers and peer educators, face-to-face communication with potential users to equip them with information and skills, an identified target audience, a consistent supply, a long assessment period to gauge actual use beyond the initial novelty phase, and a mix of public and private sector distribution. Female condom programmes require the sanction, leadership and funding of governments and donors. However, the non-governmental and private sectors have also played a major role in programme implementation. To ensure successful introduction of the female condom, it is crucial to involve a range of decision-makers, programme managers, service providers, community leaders and women's and youth groups. The rising cost of inaction and unprotected sex in the spread of HIV and AIDS force us to recognise the high cost of not providing female condoms alongside male condoms in family planning and AIDS prevention programmes.

Brazil↗
PubMed2000

Hispanic adults' beliefs, attitudes, and intentions regarding the female condom.

The present study used the theory of planned behavior (TPB) (Ajzen, 1985) augmented by AIDS knowledge to investigate factors influencing intentions of Hispanic adults to use the female condom. A total of 146 persons (75 women and 71 men; mean age, 27 years) recruited from community-based organizations completed an anonymous survey regarding intentions to use the female condom with their main sex partner. The TPB model had greater predictive utility for women's, than for men's, female condom use intentions. For men, attitudes and norms did not predict female condom use intentions, but greater AIDS knowledge was related to lower intentions to use the female condom, above and beyond the TPB constructs. Perceived behavioral control, operationalized as self-efficacy, significantly increased the predictive utility of the TPB model for women's female condom use intentions but not for men's. Behavior change strategies to increase female condom use are discussed in light of these findings.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Factors influencing condom use among African American women: implications for risk reduction interventions.

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed.

Adolescent↗
PubMed1998

Self-efficacy to use condoms in unmarried Latino adults.

Measures of self-efficacy to use condoms can clarify the barriers to condom use Latinos encounter. A 20-item scale, that differed slightly for men and women, and was based on extensive elicitation interviews, was used in a random digit dial household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Self-efficacy was related to condom use for both men and women. Factor analyses revealed five correlated factors: Regular Partner, Impulse Control, Partner Resistance, STD Thoughts, and Condom Discussion. Both men and women reported lowest self-efficacy for impulse control and using condoms with a regular partner. Less-educated men and women had lower self-efficacy to discuss condoms, to manage partner resistance, to use condoms with a regular partner, and to control impulses, but there were few other demographic differences in self-efficacy. The scale can be helpful in the design and evaluation of HIV prevention.

Adult↗
PubMed2003

Determinants of female and male condom use among immigrant women of Central American descent.

This study was designed to determine factors that influence female and male condom use among Central American women, applying the theory of planned behavior. A cross-sectional design was employed and a sample of 175 Central American women, 18-50 years old, was recruited from a community-based clinic in Los Angeles County. Participants in this study were interviewed face-to-face. Attitude, subjective norm, and perceived behavioral control explained 41% and 45% of the variation in the intention to use male and female condoms, respectively. Respondents' friends and mothers influenced their subjective norms. Beliefs regarding sexual sensation and sexually transmitted infection/pregnancy prevention affected respondents' attitudes toward condoms. Trust issues were also a major factor affecting attitudes toward female condoms. Condom use and sex negotiation skills predicted control over condoms. Results of this study can be used to design HIV/AIDS prevention programs that help women feel control over condom use and their sexual behavior.

Adolescent↗
PubMed2004

Persistence of inconsistent condom use: relation to abuse history and HIV serostatus.

This study longitudinally examines the relation between a history of experiencing childhood and adult physical or sexual abuse, and male condom use by women with or at risk for HIV. Abuse history and prospective condom use data were collected from 214 HIV infected and 189 uninfected women participating in the HIV Epidemiology Research Study (HERS) who were inconsistent condom users at baseline and received two safer sex counseling sessions. Analyses were conducted to assess the association between abuse history and condom use while controlling for sociodemographic variables and other risk factors. HIV-uninfected women with a history of adult physical abuse were five times less likely to report consistent condom use at 1-year follow-up than uninfected women without a history of abuse while holding control variables constant. Expectations of a negative reaction by the partner to suggested condom use did not explain this association. Though in the same direction as in uninfected women, abuse history was not significantly related to consistent condom use among HIV-infected women. These data indicate the need to develop risk prevention strategies tailored to uninfected women with a history of adult abuse. In lieu of specialized interventions, health care providers should assess women's abuse history and supplement HIV prevention counseling with mental health counseling when indicated.

Adolescent↗
PubMed2001

Heart versus reason in condom use: implicit versus explicit attitudinal predictors of sexual behavior.

We test the hypothesis that explicit and implicit measures of attitudes would differentially predict deliberate versus spontaneous behavior in the domain of condom use. Students completed explicit attitudinal and thought-listing measures about using condoms and implicit measures using attitude priming and Implicit Association Test (IAT) procedures. An attitude IAT measured the association between condom images and affective images; a self-identity IAT measured association of condoms with the self. We predicted and found that condom use with main partners was predicted by explicit measures but not implicit measures; the opposite was true for condom use with casual partners. Although the attitude priming measure was not positively correlated with casual condom use, the IATs were. The patterns of relations, however, were unexpectedly complex, due to a strong decrease in IAT effects over time, and different IATs assessing unique attitudinal dimensions.

Adult↗
PubMed1991

Changes in condom use among homosexual men in San Francisco.

Employed data from two longitudinal surveys of gay men in San Francisco (a) to examine for cohort (Study 1) and attrition (Studies 1 and 2) bias effects on reported changes in condom use by gay men and (b) to investigate predictors of condom use (Study 2). Substantial increases in condom use were observed, and these changes were unrelated to attrition and cohort bias. In terms of predictors of condom use, men who always used condoms had higher levels of social support from informal sources of help, had more positive expectations that condoms would have positive interpersonal and personal consequences, and were more likely to be HIV positive than men who used condoms occasionally or never. The results are discussed in terms of their implications for HIV-prevention research.

Adult↗
PubMed2006

Condom use and the risk of genital human papillomavirus infection in young women.

BACKGROUND: To evaluate whether the use of male condoms reduces the risk of male-to-female transmission of human papillomavirus (HPV) infection, longitudinal studies explicitly designed to evaluate the temporal relationship between condom use and HPV infection are needed. METHODS: We followed 82 female university students who reported their first intercourse with a male partner either during the study period or within two weeks before enrollment. Cervical and vulvovaginal samples for HPV DNA testing and Papanicolaou testing were collected at gynecologic examinations every four months. Every two weeks, women used electronic diaries to record information about their daily sexual behavior. Cox proportional-hazards models were used to evaluate risk factors for HPV infection. RESULTS: The incidence of genital HPV infection was 37.8 per 100 patient-years at risk among women whose partners used condoms for all instances of intercourse during the eight months before testing, as compared with 89.3 per 100 patient-years at risk in women whose partners used condoms less than 5 percent of the time (adjusted hazard ratio, 0.3; 95 percent confidence interval, 0.1 to 0.6, adjusted for the number of new partners and the number of previous partners of the male partner). Similar associations were observed when the analysis was restricted to high-risk and low-risk types of HPV and HPV types 6, 11, 16, and 18. In women reporting 100 percent condom use by their partners, no cervical squamous intraepithelial lesions were detected in 32 patient-years at risk, whereas 14 incident lesions were detected during 97 patient-years at risk among women whose partners did not use condoms or used them less consistently. CONCLUSIONS: Among newly sexually active women, consistent condom use by their partners appears to reduce the risk of cervical and vulvovaginal HPV infection.

Adolescent↗
PubMed2004

Safer sex or pleasurable sex? Rethinking condom use in the AIDS era.

BACKGROUND: Condom use in Bangladesh is low despite nationwide family planning initiatives and HIV interventions. METHODS: Fifty men aged between 18 and 55 years from diverse socio-demographic backgrounds and five key informants were interviewed in a qualitative male sexuality study. RESULTS: Refusal to use condoms is not only a personal choice, but pertains to relationships. The meanings of reduced bodily pleasure associated with condom use are socially constructed. Men's emotions and trust expressed through understanding of direct penile-vaginal contact and ejaculation inside the vagina as 'pure' and 'natural' sex oppose condom use. Sexual prowess in the form of prolonged intercourse without condoms, as depicted in Western pornography, was perceived as a 'real man's' sexual skill. Men sought to preserve a 'good man's' image by avoiding condoms, which symbolised promiscuous men in AIDS educational messages. CONCLUSION: Social dimensions of masculine sexuality, pleasure, eroticism and the emotional aspect of men's lives have to be addressed for effective condom promotion.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Development and validation of a condom self-efficacy scale for college students.

This study proposed to develop and validate a scale for the college population that measures self-efficacy in using condoms. The Condom Use Self-Efficacy Scale (CUSES) was derived from several sources and consisted of 28 items describing an individual's feelings of confidence about being able to purchase condoms, put them on and take them off, and negotiate their use with a new sexual partner. This scale was administered to a sample of 768 college students. It was found to possess adequate reliability (Cronbach's alpha = .91; test-retest correlation = .81) and correlated well with the Attitude Toward the Condom Scale (r = .51) and the Contraceptive Self-Efficacy Scale for women (r = .55). Our scale also correlated with a measure of intention to use condoms (r = .40) but was unrelated to a measure of social desirability. Students who differed on measures of previous condom use as well as on sexual intercourse experience also showed significant differences on this scale in the expected direction, indicating evidence of this scale's discriminant validity. The potential uses of this scale in a college population are discussed, along with the issues underlying condom usage self-efficacy.

Adolescent↗
PubMed2001

Consistent condom use in the heterosexual relationships of young adults who live in a high-HIV-risk neighbourhood and do not use "hard drugs".

This study was set up to determine the predictors of condom use in the heterosexual non-commercial sexual relationships of young adults who neither inject drugs nor use cocaine, heroin or crack, in a neighbourhood with widespread drug-use-connected HIV. The analytic sample is 279 young adults, aged 18-24, who have never injected drugs and who have not used heroin, cocaine or crack in the last year. They were recruited in the Bushwick neighbourhood of New York City, July 1997 to September 1999. A face-to-face interview included items about their sociodemographic background, substance use and sexual networks. Sexual relationship and self-reported consistent (100%) condom use over the prior year with the partner in a given relationship was examined. Subjects had 337 heterosexual non-commercial relationships. Consistent condom use was reported in 32% of these relationships. In multiple logistic regression, consistent condom use was more likely in relationships that are not 'very close' (odds ratio = 3.92; 95% confidence interval = 2.08, 7.52); in the relationships of subjects whose peer norms support condom use (OR = 1.94; 95% CI = 1.43, 2.69), who are not problem drinkers (OR = 8.70; 95% CI = 2.22, 58.8), and (perhaps as a result of measurement issues) who are men (OR = 1.95; 95% CI = 1.04, 3.68). In conclusion, consistent condom use remains uncommon among youth in this high-risk neighbourhood. It is thus important to keep HIV from entering the sexual networks of youth in communities like this through programmes aimed at drug injectors and their sexual partners. Programmes to increase condom use among young adults should focus on strengthening norms that promote safer sex to protect oneself and others. In addition, assistance should be provided to youth who are problem drinkers.

Adolescent↗
PubMed2001

The additional value of anticipated regret and psychopathology in explaining intended condom use among drug users.

Abstract In this study we examine determinants of intended condom use with casual and steady sex partners among drug users. Our aim was to find out whether anticipated regret and psychopathology represent additional factors in explaining condom use behaviour, on top of the constructs defined in traditional psychosocial models of behaviour. A questionnaire measuring intentions, attitude, beliefs, personal norm, subjective norm, descriptive norm, self-efficacy and anticipated regret toward condom use with steady and casual sex partners, and the Symptom Checklist '90 (to measure dimensions of psychopathology) were handed out to 150 Dutch drug users. The results showed that intended condom use with steady sex partners was mainly predicted by self-efficacy, personal norm and anticipated regret (total R2 = 0.41). Lower feelings of hostility and a more positive personal norm, subjective norm and attitude significantly predicted intended condom use with casual sex partners (total R2 = 0.24). The results also showed that intended condom use with steady sex partners seems to result from anticipating possible barriers, whereas condom use with casual sex partners is largely a matter of having safe sex norms. Practical implications of this study for Aids-preventive campaigns are also discussed.

Condoms↗